Intraperitoneal instillation of bupivacaine in gallbladder fossa and at trocar sites in reduction of postoperative pain after laparoscopic cholecystectomy: a prospective randomized controlled double blind trial

Abstract

Background: Pain relief remains landmark achievement attributed to laparoscopic cholecystectomy. Post laparoscopic cholecystectomy patient still complains of incisional pain, shoulder pain and vague upper abdominal pain. A simple method of portal or incisional infiltration and intraperitoneal spraying of a local anaesthetic agent over gall bladder fossa can reduce postoperative pain. The mean duration of action of bupivacaine hydrochloride is 8.07 hours which is 2-3 times longer than lignocaine.Methods: This study was conducted to determine whether local infiltration of bupivacaine at trocar sites and gall bladder fossa has any effect in postoperative pain relief. This prospective study was conducted on 60 patients (3 groups) undergoing laparoscopic cholecystectomy. In group A, 20ml of 0.25% bupivacaine was instilled subcutaneously at all trocar sites. In group B, 20ml of 0.25% bupivacaine was instilled in gallbladder fossa after removal of gall bladder. In group C, 20 ml bupivacaine was instilled at the gall bladder fossa and 20% was instilled at the trocar sites as mentioned for group A.Results: Chi square analysis of NRS of pain at 1, 6, 12, 24 hours post operatively shows significant improvement in NRS scores in group A and C compared to group B.Conclusions: Infiltration of 0.25% bupivacaine at all trocar sites with or without infiltration in gall bladder fossa is an effective method of postoperative pain relief when compared to infiltration of gall bladder fossa alone.